Individual
ABIGAIL J MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
229-231 STATE ST, BINGHAMTON, NY 13901-2756
(607) 778-1119
(607) 778-1164
Mailing address
14 GRANDVIEW AVE, CONKLIN, NY 13748-1215
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R040569
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000023526
EXCELLUS (BC/BS)
NY
05
—
07300040569
—
NY
Enumeration date
06/12/2006
Last updated
08/27/2010
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